Saturday, February 27, 2010

Clueless to street smart

I remember the days when I thought that being a doctor meant knowing everything in the medical books. Can't take care of people unless you know the real stuff, right? Have to know the difference between Gram negative and Gram positive bacteria, and what treats which. How to tell dangerously low blood pressure caused by infection or by heart failure. Why to check a blood pressure when children traipsed in with muddy urine specimens.

Too bad that's not all I needed to know.

The trouble with being a relatively headstrong person (a quality that has both served me well and resulted in some my-head-sized indents in too-strong walls) is that it can be difficult to convince such a person that they need to know more. But...I never wanted to be one of those book-smart, street-dumb people.

I remember wanting to be with my Dad, an auto mechanic/tow truck driver/jack-of-all-trades, to watch him work on cars and generally do "stuff." I did well in school, but I didn't know how to do "stuff." However, I also remember him telling my Mom he didn't want me to do any of that "stuff" because he didn't want me to be like him.

One summer, I recall trying to landscape with him. My task was to rake out the stones that were to cover an area we had weeded. It looked easy...but I couldn't figure out how to lever the rake so I could grab the stones to pull them back - the rake kept skittering and clanging over stones, pulling just a few with them. That was tough, but what was even tougher was my Dad grabbing the rake from me because I couldn't figure out how to do it fast enough...though I think my whining about it probably got to him worse.

So, I guess I didn't want any sick kids skittering away from me. I tried to pick up clues that might help me during my training, anything that might help, from anyone who'd offer. After all, the books might say, "during respiratory failure, a bag-valve-mask should be used to temporize the patient until an endotracheal tube can be placed." The book did NOT say how to put the mask on, how not to blow out the child's lungs, nor how to do any of that with the parent in the room, freaking out about every parent's worst nightmare.

So I tagged along with the respiratory therapists - the two Marcs were my favorites. The older one knew how to keep a kid breathing using any way imaginable, always talking in his low, short-bursts-of-words, kind of way. Marc the younger taught me how to have squirt gun fights with saline bullets, and that loud monkey noises are better. After all, sick kids are still just kids.

I listened to the technologists about being gentle with sick kids lying on hard x-ray tables. I followed the nurses around - especially Peggy, on whose filed teeth are speared residents from years past; my IV skills would be nonexistent if not for nurses like her. In the NICU (neonatal intensive care unit, where all the sickest infants and preemies received care), I got an "A" bed grade for being able to wrap a preemie up in a blanket and have it look like a nurse had done it. Well, ALMOST like a nurse - it wasn't expected for any of the doctors to be able to do it THAT well. My A was their B...right, Mary?

In the PICU (pediatric ICU), I really grew up learning from the nurses. The PICU was the place for real doctors, not for timid residents hiding behind clipboards. There, the attendings regularly snacked on clueless residents; the rest got dropped of a cliff, Wile E. Coyote-style, thinking they knew more than the nurses.

The nurses RAN that place. You want to figure out the exact way a kid was sick, and why? Maybe talk to the resident. Save the child's life RIGHT NOW? The nurses were always there, tirelessly, fearlessly. They taught me how not to take myself too seriously. How to be brief (medical students, residents, and maybe some blogger pediatricians talk WAAAAAY too much sometimes). How to avoid the attending when she's pissed off. How to put in an IV without making a (literal) bloody mess over their bed. How to do the right thing, even if it was saying,"I don't know." How to sleep when they could handle the unit, knowing they'd get me if they needed me...that is, needed me to be there so I could learn what I was supposed to be doing.

I changed diapers - even disgusting ones. Had crazy little people vomit on me, cough in my face, and spit at me. Calmed the kid with the thin spike stuck in his fingernail from my trying to drain blood from under his fingernail. Picked out snot from a toddler's nose with my fingers. Had an angry teen chuck a pencil 2 inches from my head. Tackled a seriously disturbed teen in the ER with Security. Held hands with the family of a child I helped to die peacefully after her long struggle with cancer.

Now,the families I see teach me about their kids. I listen, nod my head, and, more often than not, use my street smart head first, with the occasional input from my book smart head. I may be hard-headed, but I have come to understand that 2 heads are, after all, better than 1.